Chapter 7: Assuring Safety and Security in Healthcare Institutions

Safety and Security – Risk? Health facilities that experience adverse events due to safety or security issues can incur penalties ranging from large fines to loss of accreditation. An aggressive and well-organized safety and security management program can help minimize risk of and adverse event.

Regulation and Accreditation Medicare and Medicaid require a participating healthcare organization to satisfy the Conditions of Participation (CoP) relevant to the management of safety and security. Accreditation by the Joint Commission, DNV Healthcare Inc. or HFAP ensures that the facility meets the CoP requirements State Departments of Health also regulate safety and security in healthcare organizations

Safety vs. Security Safety can be a broad category with standard policies and procedures throughout a facility or system. Hand-washing policy Use of Personal protective gear Hazardous waste disposal Security must be more site specific. Safety and security policies sometimes conflict.

High Risk Events A facility may incur major penalties if a “never” adverse event occurs (an event that should not occur if appropriate safety/security measures were in place) CMS may not reimburse costs of a never event and many third party payers have a non- reimbursement program as well.

Techniques for Managing Safety and Security Risk Assessment Estimate Failure Modes and Effects Analysis (FMEA) Root-cause Analysis (RCA) Technological Redundancy Crew Resource Management Red Rules

Potential Environmental Hazards OSHA has a list of the types of hospital-wide hazards and provides information on how to prevent and respond to them Three categories of hazardous materials Biological Chemical Radioactive

Security: Unwanted Intruders Use of high-tech solutions to manage visitor and employee access Automated turnstiles with card swipe readers for employee entrances Visitor areas/desk where all visitors enter and sign-in. Employee ID badges Secured areas

Potential Security Hazards Theft of Patient Valuables/Employee theft Infant abduction Workplace Violence Gangs

Patient Valuables Provide a safe in the building to house valuables Provide receipts for any valuable stored by facility Encourage patients to leave valuables at home or give to family to take home

Violence in the Workplace Patients have a right to treatment but staff have a legal right to a safe workplace Watch for signs that may lead to violence (in patients, visitors and staff) Anger Stress Under the influence of drugs/alcohol

Gangs Many health facilities treat victims of gang violence and occasionally the dispute continues upon arrival at the facility. Use of metal detectors is increasing to prevent entrance of weapons into the health facility

Information Security With increasing use of information management systems, healthcare facilities must insure that the system itself is secure from unauthorized access or violate HIPAA regulation Entry to system is password or thumbprint protected Use of firewalls to block unauthorized internet access Use of Virtual Private Networks

Fire Safety Health facilities must comply with NFPA standards for fire suppression systems, fire barriers, smoke compartments, detectors and alarms, and emergency exits and lighting Defend in Place Fire Safety Plans and Training

Facility Design and Operation The design of the physical plant can help ensure safety and security of the facility Proper ventilation design can ensure indoor air quality and safety Use of improved technologies to keep water clean and prevent growth of bacteria Use of technologies to prevent scalding from high water temperatures

Emergency Preparedness Dedicated resources for emergency preparedness Designation of a command structure Culture of continuous training Frequent and critiqued disaster drills Constant updating of plan to reflect changing risk and conditions

Types of Threats Security Utility Failures Geologic Structural Other

Plan for Information System Continuity As healthcare organizations rely more heavily on information technologies, it is imperative that there be a specialized disaster plan for information technology. Backup data systems Independent emergency power supplies Alternative network communication

Summary Safety and security incidents can be serious threats to the financial well-being of the healthcare organization. The Risk Manager must be aware of potential safety and security situations and ensure policies and procedures are in place to minimize the risk of an incident.